In response to the Office of Inspector General’s (OIG) findings of $1.5 billion in inappropriate Medicare spending, the National Association for Home Care & Hospice (NAHC) expressed support for tighter Medicare regulations in skilled nursing facilities (SNF).
The OIG found that SNFs billed one-quarter of all claims in error, resulting in $1.5 billion in unsuitable Medicare payments. OIG noted that many of these erroneous claims were for high-intensity treatments unsuitable for certain SNF patients.
To quell further abusive billing, OIG recommended a number of suggestions to Centers for Medicare & Medicaid Services (CMS) with the intent of increasing examinations to prevent fraudulent spending.
The suggestions included increased reviews of SNF claims; use of CMS Fraud Prevention System to identify SNFs that are billing for higher resources; monitor compliance with new therapy procedures; change the method of determining the amount of therapy needed to ensure appropriate payments; improve minimum data set items which help identify resident ailments; and finally, follow-up on the infringing SNFs.
“We have long supported the establishment of minimum national standards for worker competencies, qualifications and background screenings whether the care is provided by individual caregivers or home care agencies,” said NAHC President Val J. Halamandaris.
OIG believes that further compliance must be sought between SNFs and CMS concerning the correct appropriation of funding and treatment for patients.
“The fraud committed by the very few, hurts all of home care and the patients we serve. The industry must be a leader in health care compliance and program integrity,” added Halamandaris. “NAHC has made great progress in that regard and will continue to set the gold standard for all of health care.”
Written by Jason Oliva